Mid-Term Outcomes of Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy in Patients With Sigmoid Versus Neutral Ventricular Septum
Abstrakt
The aim of this study was to determine whether the differences in the baseline septal morphology influenced outcomes of patients after alcohol septal ablation (ASA). Methods.
A total of 100 consecutive, highly symptomatic patients with HOCM and a neutral or sigmoid septum (74 patients vs 26 patients) underwent ASA and were examined clinically and echocardiographically at baseline and at follow-up (median 30 months vs 24 months). Results.
At baseline, a neutral septum morphology was associated with a thicker basal septum [21 (19-24) mm vs 19 (18-20) mm; P<0.01] and higher pressure gradient at rest [59 (39-80) mm vs 43 (33-50) mm; P<0.01], but a similar pressure gradient after provocation [100 (72-120) mmHg vs 97 (70-110) mmHg; P=0.31], and subsequently both resting gradient [10 (10-16) mmHg vs 12 (10-15) mmHg; P=0.67] and provoked gradient after ASA [20 (1030) mmHg vs 18 (12-25) mmHg; P=0.71]. Four patients died during follow-up (4% vs 4%; NS).
Pressure gradient, septum thickness and symptoms decreased significantly in both groups. Conclusions.
Patients treated with ASA who had a sigmoid septum were characterized at baseline by a thinner basal septum and lower pressure gradient at rest. However, they showed an identical pressure gradient after provocation and subsequently after ASA.
ASA was safe and effective in both groups of patients.